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Biomedical subjects

M F Tenholder

Publications and source records attributed to M F Tenholder.

At least 37 records · Page 2Linked to original sources
PubMed1992

Complex cryptococcal empyema.

Cryptococcus neoformans continues to present diagnostic and treatment challenges in patients with underlying malignant neoplasms. Cryptococcal empyema is a relatively rare complication of cryptococcal disease. It is important to distinguish whether uncontrolled malignancy or cryptococcal infection is responsible for the effusion. We used traditional diagnostic approaches, bronchoscopy and transthoracic fine needle aspiration, to verify the presence of the organism but continued to have treatment failure until adequate drainage was established.

Cryptococcosis↗
PubMed1992

A model for conversion from small volume nebulizer to metered dose inhaler aerosol therapy.

Rationing of medical services will be necessary if we do not develop a more rational and efficient health care system. Respiratory care services are receiving emphasis as we try to curtail spiraling health care costs. In analysis of our respiratory care services, we found that small volume nebulizer (SVN) therapy was still a major portion of our workload. We instituted a protocol to convert to metered dose inhaler (MDI) therapy. All hospitalized patients, excluding those admitted to the spinal cord unit and intensive care units, with a physician's order for aerosol delivery by SVN, were evaluated by respiratory care practitioners for conversion to MDI therapy. A simple protocol for the therapist to use in this conversion was developed. All patients converted to MDI were trained in appropriate MDI use by the therapist. A three-day follow-up of each patient's compliance with proper MDI therapy was initiated. Even with a 72-h allowance for initial SVN treatment, we realized a 9,350 procedure reduction from deleted treatments and an additional 7,650 conversions to MDI. Less than 2 percent of our patients failed to make a completely successful conversion to MDI. Those patients who successfully converted to MDI resulted in reduced hospital costs of $43,758 based on excess medication, supplies, and labor costs associated with SVN treatments. We also saved 5,000 h of technician time that was used to further instruct patients in appropriate MDI therapy. Aerosol therapy by MDI is cost-effective therapy. The institution of guidelines for MDI conversion has reduced fear of failure for both clinicians and patients and illustrates the importance of patient education by qualified respiratory therapists.

Adrenergic beta-Agonists↗
PubMed1992

Invasive Aspergillus niger with fatal pulmonary oxalosis in chronic obstructive pulmonary disease.

The ubiquitous Aspergillus fungus has numerous manifestations when associated with lung disease (primary Aspergillus pneumonia, aspergilloma, allergic bronchopulmonary aspergillosis, and invasive Aspergillus). This fungus also can colonize preexisting lung disease in an indolent manner and then acutely assume a more invasive nature. Although the species Aspergillus niger is infrequently encountered, the endobronchial visualization of black necrotic debris or a fungus ball or the finding of black acidic sputum or pleural fluid suggests the presence of A niger and the destructive by-product of its fermentation, oxalic acid.

Aspergillosis↗
PubMed1992

Rhodotorula rubra contamination in fiberoptic bronchoscopy.

Rhodotorula rubra was recovered in 18 bronchoscopic specimens from 15 patients from May to November 1987. One hundred and twenty-one bronchoscopies were performed during that period by two bronchoscopists (W. W.; R.D.) at Letterman Army Medical Center in San Francisco. Isolation of R rubra occurred in 11 bronchoalveolar lavage (BAL) specimens, four bronchial washes, and three transbronchial biopsies. Clinical infection was not present in any of these patients, although five were immunocompromised hosts. After a stepwise infection control review of the laboratory, the bronchoscopy suite, bronchoscopists, and the fiberoptic bronchoscope failed to recover the organism, a systematic evaluation of the cleaning procedure was undertaken. We discovered that replacement of the suction valve and the rubber biopsy valve on the biopsy channel immediately after cleaning allowed moisture to accumulate in these areas. Removal of both the suction valve and biopsy valve during periods of nonuse resulted in adequate drying of the biopsy channel and eradication of contamination from December 1987 to May 1990 (350 bronchoscopies). Epidemiologic and infection control surveillance is critical for bronchoscopy, especially when possible pathogens are recovered by BAL in the immunocompromised patient.

Bronchoalveolar Lavage Fluid↗
PubMed1992

Can MDIs be used effectively by extubated ICU patients?

Metered-dose inhaler (MDI) therapy can be an effective, cost-efficient means of managing chronic airway obstruction in many patients in medical or surgical intensive care units who have recently been extubated. Because medication is delivered directly to the airways through an MDI, a relatively low dosage may be effective, and few adverse effects may be encountered. Candidates for MDI therapy should have a vital capacity of at least 900 mL, be able to hold their breath for at least 5 seconds, and have a respiratory rate of under 25 breaths per minute. The majority of patients who meet these criteria are able to convert to MDI therapy within 24 hours of extubation.

Adult↗
PubMed1992

Exercise responses prior to pregnancy and in the postpartum state.

Increased women in the work force and requirements for maximal employee productivity have necessitated examination of the optimal time for parturients to resume normal activities. This prospective study was designed to determine whether prepregnancy measures of aerobic capacity are regained by 4-8 wk postpartum. Weight, percent body fat, recall energy expenditure, and exercise responses via a stage 1, graded cycle ergometer exercise test were determined in 11 subjects (mean age = 27.56 +/- 2.2) in a postabsorptive state prior to pregnancy and 4-8 wk postpartum. Subject characteristics were compared by the Student's t-test and differences across workloads and time by analysis of variance with repeated measures. Prepregnant weight (mean = 58.80 +/- 7.26 kg) was significantly less (P less than 0.05) than postpartum weight (mean = 62.81 +/- 9.12 kg), and prepregnant energy expenditure (1352 +/- 453 kJ) per day was significantly higher (P less than 0.05) than in the postpartum period (274 +/- 333 kJ). Maximal oxygen uptake was significantly higher (35.2 +/- 0.7 vs 30.5 +/- 2.0 ml.kg-1min-1) in the prepregnant as compared with the postpartum period. Further, heart rate at 125 and 150 W was significantly lower prepregnancy as compared with postpregnancy. Results support a detraining effect in the early postpartum period. Whether this detraining is an inevitable factor associated with pregnancy or whether exercising throughout pregnancy can ameliorate the decline in aerobic capacity postpartum is uncertain.

Adult↗
PubMed1991

Effect of anorexia nervosa on pulmonary immunocompetence.

Pulmonary infection due to opportunistic organisms and usually nonpathogenic mycobacteria may occur whenever immune defenses are weakened by external factors. These factors include neutropenia, treatment with corticosteroids or cytotoxic agents, previous antibiotic therapy, and nosocomial hazards (eg, catheters, ventilators). Nutritional deprivation is also often implicated as an important coexistent variable. An infection due to Mycobacterium xenopi (usually a nonpathogenic mycobacterium) in a patient with anorexia nervosa and no other predisposing factor for infection provides a model for discussing the possible effects of malnutrition on pulmonary immunocompetence. Since pulmonary infection in anorexia nervosa is often subtle, early evaluation of depressed cell-mediated immunity is appropriate.

Adult↗
PubMed1991

Urinary desmosine excretion as a marker of lung injury in the adult respiratory distress syndrome.

Desmosine, the intermolecular and intramolecular cross link between the chains of elastin polypeptide, may be useful as a marker of a lung injury in adult respiratory distress syndrome (ARDS). A radioimmunoassay for rabbit antibody developed against desmosine, conjugated to bovine serum albumin, can detect as little as 100 pg of desmosine in plasma or urine. Desmosine is not metabolically absorbed, reused, or catabolized by the body, but rather eliminated unchanged in the urine as low molecular weight peptides. The lung is relatively rich in elastin, and we reasoned that a timed collection could be used as an index of elastin degradation in vivo. A 2-h collection of urine for desmosine assay was obtained at the time of Swan-Ganz catheter insertion in 41 consecutive patients. On the basis of clinical and initial Swan-Ganz catheter data, the patients were assigned to one of three groups: an ARDS group (n = 12); a cardiogenic pulmonary edema (CPE) group (n = 12); and a critically ill, nonpulmonary edema group (NPE, n = 17). The mean urine desmosine concentration (mg/L) for the ARDS group (0.728 +/- 0.22 SE) differed from the CPE group (0.149 +/- 0.07; p less than 0.001). The total excretion (microgram/2 h) was 64.95 +/- 24.7 in the ARDS group and 24.71 +/- 11.7 in the CPE group (p less than 0.05). Urine desmosine concentration/serum creatinine index for the ARDS group (0.78 +/- 0.28) was greater than in the CPE group (0.07 +/- 0.04; p = 0.019). Desmosine excretion was increased in the NPE group compared with CPE and ARDS groups, possibly reflecting heterogeneity in this group. In the differentiation of ARDS from CPE, we conclude that substantial increases in urinary desmosine excretion favor a diagnosis of ARDS.

Adult↗
PubMed1991

The acute and insidious onset of pulmonary metastatic transitional cell carcinoma.

Transitional cell carcinoma is a common urologic neoplasm. Although pulmonary metastases from this tumor are often not appreciated clinically, they are frequently documented in autopsy studies. Therefore, the clinical recognition of this condition can be problematic. To illustrate this point, we present three patients with progressive unexplained dyspnea and histories of transitional cell carcinoma. Since ineffective and possibly detrimental therapeutic approaches may be initiated, a high index of suspicion for pulmonary metastatic embolization must be maintained. Early histologic identification of these metastatic emboli and initiation of effective chemotherapy may prove beneficial for improved quality of life.

Acute Disease↗
PubMed1990

Obligate mouth breathing during exercise. Nasal and laryngeal sarcoidosis.

A young black man presented with simultaneous nasal and laryngeal sarcoidosis, each uncommon entities. Despite severe upper airway obstruction and emergent tracheostomy, there was an uncharacteristic rapid response to oral steroids alone. The patient's predominant initial complaint of early mouth breathing during routine army physical training demonstrates a symptom complex and an alternate mechanism of dyspnea to consider in sarcoidosis.

Adult↗
PubMed1990

The impact of thoracic computed tomography in clinically staged T1, N0, M0 chest lesions.

We assessed the impact of thoracic computed tomography (CT) in 38 patients considered for thoracotomy for solitary pulmonary lesions characterized as T1, N0, M0 by clinical and roentgenographic staging. False-positive lymph nodes were identified by CT in four patients prompting additional surgical staging procedures in two cases. Two of three patients with false-negative clinical, roentgenographic, and CT findings had successful complete resections. The CT scan did not correctly advance the stage of, or alter the plan for, these lesions in any patient. We conclude that CT is not helpful in patients considered for diagnostic and therapeutic thoracotomy for clinical and roentgenographic T1, N0, M0 lesions.

Adenocarcinoma↗
PubMed1989

Diagnosis and treatment of metastatic ameloblastoma.

Although there are several theoretic mechanisms for metastasis of ameloblastoma, hematogenous and lymphangitic spread are the most likely. Metastatic ameloblastoma in the lung can be accurately diagnosed by transbronchial biopsy. Surgical excision of metastatic ameloblastoma is one choice for treatment, but there is no good evidence that this benefits the patient. Treatment of metastatic ameloblastoma with previously used chemotherapeutic regimens has shown little clinical response and has always been followed by disease progression. There may be a role for our chemotherapy regimen for local control in dangerous locations, thereby facilitating further surgical removal and minimizing postoperative sequelae.

Adult↗